DEP/DUA/1/12/09 (Normalised version)

Betty McIntosh

(1776-1777)

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Betty McIntosh.

Disease not totally without difficulty.

Yet almost every part of affection obvious.

Can by no means however refer whole symptoms to one genus.

What may consider as principle part of complaint is dry scabby eruption upon head.

In affixing name to this part of affection no hesitation.

From seat, from appearance & nature of eruption can have no doubt in pronouncing it Tinea Capitis.

An affection not uncommon & frequently very obstinate

In so much that after certain standing some disposed to rank it among incurable affections

But this although to be considered as most considerable not only part of patients complaint.

Perhaps even not what in present instance will be most obstinate.

Patient affected also with considerable dullness of hearing

This also considered as characteristic of a genus of disease among all nosologists¹.

Under terms Dysecoea, Cophosis, Surditas etc

Each genus comprehending various species

Which however to be considered chiefly as instance of the disease proceeding from different causes.

What particular accident in present instance giving rise to it a matter of great doubt.

Some presumption however that may have been affect of disappearance of eruption.

Repulsion of cutaneous diseases enumerated among causes of great variety of affections.

And from none more frequently affections said to proceed than from repulsion of Tinea.

Do not however observe that any practical author has mentioned deafness as one of them

Has been said however to induce blindness.

And if occasionally affection of one senses now mentioned gives at least presumption of other.

Would I own then be inclined to attribute present deafness to former removal of the affection.

Which as far as we can learn not affect of any particular remedy but a natural cure.

Still however may I apprehend have been product of same affect, as if artificial cure.

As evidently indicating a different state of circulation

Besides these two affections may be at least question whether patient be not affected with third

Is observed to have uncommon largeness of belly.

And to be affected with inclination to vomiting particularly in morning.

In neither of these separately evidence of any particular affection.

Nor indeed in both conjoined.

At same time little reason to think that connected with any other of affections already mentioned.

How formerly be incipient state of more material affection than any yet mentioned hard to say.

But as far as can at present judge should not look upon it in that light.

And am I own disposed to view it, as least considerable part of patients complaint.

And respecting event of it have least apprehension

Of two others somewhat doubtful in opinion.

From Tinea having before yielded, grounds for favourable judgement.

Yet is an affection not unfrequently admitting of temporary cure.

And as was the case when formerly disappeared may again without any obvious cause return.

But still greater reason to be afraid of obstinacy of deafness.

For since first commenced has suffered no obvious remission.

And at same time no manifest disease in the ear can be discovered.

Here evident that in cure different objectives to be had in view.

As already mentioned what reckoned principle objective of attention was disease of head or Tinea.

And at same time that part of complaint in treatment of which expected to be most successful.

Although look upon it to be in every instance an obstinate affection.

While say this, am at same time convinced that if patients will submit to the remedy one which may in by much greatest number of instances be cured

And such a cure frequently affected by an old woman in neighbourhood of Edinburgh.

Principle on which her remedy, by no means an uncommon one in other parts of country proceeds, is very obvious.

Little doubt that this one of those cutaneous affections to be considered as a disease of the roots of the hair.

May therefore look for radical cure on two grounds.

By removing diseased parts.

Or by destroying them.

Is on first of these principles that practice to which now allude proceeds.

Practice is application of pitch plaster to head.

Allowed to remain so long as to be firmly impacted in hair.

And cannot be removed without entirely pulling these along with it.

In such removal cure from this practice solely consists.

Though an affective cure however must be allowed a very severe one.

And indeed so cruel that few regular practitioners will I believe be found to venture on it.

Is on this account therefore that in present instance [illegible] rather to direct endeavour to destruction of parts

And with this view had recourse to corrosive sublimate.

A medicine affects of which as a peculiar stimulant on topical application unquestionably very great.

And in other instances of Tinea have seen it attended with best affects.

With present patient however cannot say that affects such as expected.

At same time had evidently good affects at least to certain extent.

And although did not entirely remove at least diminished the affection.

Probably also aided not a little the medicine which afterwards employed.

For found it here inconvenient to continue application of corrosive so long as intended

Was in some respects product of more affect than intended.

From being firmly impacted in hair was likely to operate in same manner as pitch plaster.

This led me to substitute to corrosive the use of the Verdigris.

An application also not infrequent in present complaint

From use of this obtained I own greater affects than expected.

For week following found head as free from scabby eruption as if had never taken place.

Would not however entirely ascribe this to Verdigris

Am persuaded that affect more remarkable in consequence of previous application of Corrosive.

But whether from one or other or both have obtained, if not permanent, at least temporary removal of this affection.

And while patient in present state next objective of cure is the deafness.

Here must own somewhat at loss on what principle to proceed.

Principally as great doubt respecting particular cause of deafness.

In greater number of cases however may consider deafness as from one of two sources.

Either want of free communication of impression to nerves

Or want of due sensibility in nerves when improperly communicated to them

How far one or other any concern in present case at a loss to say.

Or if communication obstructed from what particular cause greatly in dark.

Must own therefore that trials with view to cure in great measure random ones.

From having succeeded cure of former eruption some presumption that may have been affect of change of circulation.

At least one chance of restoration by another alteration of balance.

With this view therefore meant to try affect of supporting for some time running from neck

To this measure the rather induced as apprehend from it some good affect as preventing return of eruption.

As not only drain from neighbourhood of parts formerly affected, but also change of determination in circulation on surface of head

This therefore consider at least as reasonable trial.

If however found ineffectual must have recourse to other trials

And with this view mean to pay first attention to state of communication for impression.

Few measures perhaps more affective for removing obstruction in passage than syringe with warm water

And has farther advantage of being no improper means of augmenting secretion where diminished.

And thus giving proper condition to parts for communication of sound.

If in this way insufficient other measures may be tried

Example stimulation of Camphor oil within ear introduced by cotton

Where stimulation necessary have been informed that often remarkably good affect from Burgundy Pitch introduced into meatus auditorius.

Formed into such a shape as to be readily put into it

And in order to prevent attachment covered with a bit of gauze.

This I am informed a great nostrum with an empiric some time ago in this city who confined practice entirely to cure of deafness.

And who is said to have succeeded even with this simple remedy where regular practitioners had failed.

Must however observe that speak of this remedy only on report of others.

And cannot help thinking that is one which in some cases may be product of [illegible]

For notwithstanding covering with gauze should pitch melt in ear may give much [illegible]

And to be remarked that Pitch Burgundy one of those articles of materia medica² very apt to be adulterated.

And indeed history as brought from Saxons not well ascertained.

Some contend that is merely common turpentine boiled up.

But whatever original composition or preparation no doubt that some in habit of making it in this country from proper mixture of Turpentine with a proportion of rosin.

From this circumstance probably has very different degrees of consistency.

Thus more or less apt to melt.

Unless therefore reason to presume that affect in another manner than from stimulation should rather be disposed to try other practices.

And as stimulant should expect more from camphorated oil.

Perhaps may consider as still more affective stimulant than either the introduction of garlic into the ear.

And should practice already mentioned fail, mean rather to try this than the Pitch Burgundy.

As reason to expect from it some affect also as affecting sensibility of nerve.

For on want of due sensibility as have already hinted, rather than on state of the passage affection may depend.

And is with this view that before dismiss patient have thoughts of trying with respect to deafness the use of Electricity.

If all these seem abortive shall I own have but little expectations.

And singular is an affection which in many instances neither to be cured nor alleviated.

Of treatment required for swelling of belly & vomiting say nothing.

For apprehend that will require little else than regulation of diet.

In this manner then some view of treatments already prosecuted & hereafter intended with present patient.

Yet not impossible that from recurrence of former symptoms or from fresh appearance shall be inclined to drop it

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Explanatory notes:

1) Nosology is the branch of medical science dealing with the classification of diseases. Individuals referred to in the case notes as nosologists were commonly those who had published nosological, or classificatory, medical texts.

2) Latin term referring to the body of collected knowledge about the therapeutic properties of any substance used for healing (i.e. medicines).